Posted By Dan Marlowe,
Friday, May 9, 2014
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Growing up professionally in the field of integrated care has certainly been one heck of a ride over the last eight years. As a student and now as a professional, I have had the privilege of helping to design, implement, and refine collaborative/integrated care programs in a wide variety of primary and specialty settings. However, being a student for most of that experience, my focus was oriented primarily on outcomes (clinical hours for licensure, fulfilling the expectations of my supervisors, completing my thesis/dissertation, etc.), which left very little time and energy to think about the process of how those outcomes were achieved.
|After graduating with my PhD and landing my first “grown up” job as the director of behavioral science for a family medicine residency program, however, that very myopic focus was forced to expand. Not only was I tasked with teaching behavioral science but also with building an integrated care curriculum and complementary clinical model for our organization’s family medicine center. So, somewhere between my immense excitement with such a wonderful opportunity and the mind numbing fear of…well, blowing such a wonderful opportunity, I resolved to put some intelligible structure to my process. I spoke with colleagues and faculty alike asking them for their insights, and yet I was still lost. However, it was only after a chance conversation I had with my father (the car salesman) that I finally realized what I had been doing for so long without knowing it, and what any behavioral health provider should not only know, but more importantly, embody when building an integrated model.|| |
My father has been in the car business for over 30 years, and for the last 15 years his “forte” has been the restoration of failing dealerships. To think of it in terms of reality shows, he’s been a “Chef Ramsey” of sorts for dealerships struggling financially. By all accounts he excels at what he does, and not only do these dealerships recover but often end up stronger than when they were performing at their best. So, I made the remark that he must be a “master salesman.” After all, he has devoted half of his professional life to selling entire groups of people on the idea of change. I figured he would take this as a compliment, but his reply was more along the lines of “Son, you really have no idea what I do, do you?” That was when my father told me what his job really entails.
There are two types of salesmen in the world
|He said that there are two types of salesmen in the world: the first, and I am sure we have all had the unpleasant experience of meeting this type, converge on customers when they walk into a dealership like a second year grad student on a Starbucks venti Caramel Macchiato. They seem to already think they know what the customer wants and knows more about those wants than the customer themselves…“Oh, you don’t want that one, you want this over here…No, no, no, that might seem like an added expense, but you really SHOULD get the extended warranty…” No matter what the customer thinks, no matter what their reasoning, if it deviates from that of the salesman, the goal becomes “selling” the customer on the salesman’s idea of what REALLY is best. |
Sound familiar and, more importantly, sound annoying?
The second type of salesman, he said, sits back and watches customers when they come into the dealership. They pay attention to everything the customer looks at, they look for patterns in what models they go to first, what aspects of the cars they look at longer than others, and only after they have watched them for an extended period of time do they approach. “I noticed you spent quite a bit of time looking at that model, is there anything in particular about it you are interested in?”
Notice the difference?
|These types of sales people spend the vast majority of their time asking questions, being interested, and letting the wants/needs/desires of the customer guide what they eventually show them. This, my father said, is the key to what he does and why he hates the idea of selling anyone on anything. |
In the end, my dad said that great salesmen don’t actually sell anything; they GIVE the customer what they ask for. Instead of walking into a dealership and telling employees what they NEED or SHOULD do differently, he watches, waits, and then asks what they WANT to be different. Only after he feels like he has understood those wants does he help formulate a plan of change, a plan that incorporates those same wants as the main outcomes. So, what my father has devoted the last 15 years of his professional existence to hasn’t been selling outcomes but giving organizations a process for changing their inter-organizational relationships.
Great salesmen don’t actually sell anything; they GIVE the customer what they ask for
Now, what does any of this have to do with integrated/collaborative care? The short answer….everything….
|More than once, I have seen well-intentioned behavioral health providers try and “sell” a healthcare system on their brand of collaboration, integration, or the like. We all have done it at some point, and we might even do our sales-dance very well most of the time. We proselytize about research on the effectiveness of collaboration and integration in treating behavioral health and medical issues. We point to increased patient and provider satisfaction, and we even throw out cost effectiveness as another benefit. Ultimately, we tout integration as a panacea for “everything that ails ya,” but how often do we ever stop to ask what that “ailment” really is before offering our brand of cure? |
To be honest, I have no idea how an integrated model should or needs to look at a site, but I do know the process that needs to happen in order for integration to be useful- and it is a process exclusively about building, supporting, and maintaining relationships. Now I know that is not very sexy (yes, I just used that term), I know that it does not carry the same weight as some of the other buzz words we have come to know and love when selling integrated care- a rather overlooked aspect of our IC “lexicon.” However, the quality of relationships between members is at the very foundation and heart of any successful team. We know this implicitly- even our seminal works about integration are littered with terms like understanding and appreciation1, which are inherently systemic and more appropriately, relational in nature.
Yet even with this relational knowledge we continue to “sell” integration as a model- a shiny new car that will make you thinner, have a fuller and richer head of hair, and will make you down-right more likable as a person. Up to this point our sales technique has been one of telling
about features; telling
about research, telling
about effectiveness, telling
about cost savings. In all of my time involved in this field I have yet to hear us asking- WHAT would YOU like this model to look like, HOW do YOU think this way of doing things might be useful to you, WHAT do YOU want to achieve by practicing this way. You see, at the end of the day we have been working so hard to create models that we have forgotten that it is not about building something successful- it is about building something useful; and utility is never about selling people on what we think they need, it is about giving them what they ask for.
So, at the end of the day what kind of salesperson for integrated care are you?1Doherty, W. J., McDaniel, S. H., Baird, M. A. (1996). Five levels of primary care/behavioral health collaboration. Behavioral Healthcare Tomorrow, 5(5), 25-28.
Dan Marlowe, PhD, LMFT, is the Director of Behavioral Health at Campbell University School of Medicine. He holds a doctoral degree in Medical Family Therapy and master's degree in Marriage and Family Therapy from East Carolina University in Greenville, NC. Dr. Marlowe has primarily been embedded in medical settings over the course of his professional career, working alongside physicians to help manage the mental and behavioral health needs of their patients. Dr. Marlowe has published both nationally and internationally on interprofessional collaborative care, as well as presented at regional, state and national levels on collaborative care program development, teaching integration in graduate medical and behavioral health education, and the use of family therapy as a practice change model in healthcare settings.
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